Provider Demographics
NPI:1356344329
Name:WEISGARBER, BRANDEN LLOYD (PHD, CRNP)
Entity type:Individual
Prefix:DR
First Name:BRANDEN
Middle Name:LLOYD
Last Name:WEISGARBER
Suffix:
Gender:M
Credentials:PHD, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 RUSSELL DR NW
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8418
Mailing Address - Country:US
Mailing Address - Phone:330-878-5627
Mailing Address - Fax:
Practice Address - Street 1:1261 WOOSTER RD
Practice Address - Street 2:STE 140
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1569
Practice Address - Country:US
Practice Address - Phone:330-674-9675
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP04723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2306883Medicaid
OHWENP03011Medicare ID - Type Unspecified
OH2306883Medicaid